Adjustable implant

ABSTRACT

An adjustable implant is disclosed herein. The adjustable implant may comprise a shell including membrane and a base and having a first diameter in a plane parallel to the base. A band may be disposed within the shell. The band may have a first end and a second end connected to a spool. The band may be in a round (e.g., elliptical) configuration having a second diameter in the plane that is less than the first diameter. By wrapping the band onto the spool, the diameter of the band may be decreased and the height of the implant may be increased. By unwrapping the band from the spool, the diameter of the band may be increased and the height of the implant may be decreased.

CROSS-REFERENCE TO CO-PENDING APPLICATION

This application is a counterpart of U.S. patent application Ser. No.15/693,965, filed Sep. 1, 2017, and Ser. No. 15/807,017, filed Nov. 8,2017, both of which are incorporated by reference in their entirety.

FIELD

The subject matter disclosed herein relates to breast implants for usein a subject.

BACKGROUND

Tissue expanders are used to assist in stretching skin of a subject toprovide a tissue pocket or capsule having an appropriate size toaccommodate a permanent implant, such as a breast implant. In typicalusage, the tissue expander is implanted into a subject to help preparethe subject to receive a permanent breast implant. The tissue expandermay be expanded by introducing additional material therein, e.g.,saline, until the desired size of the pocket or capsule is achieved, atwhich point the tissue expander may be removed. A permanent breastimplant may then be implanted into the subject.

Certain tissue expanders may be used as an adjustable breast implant,such as the Becker Expander/Mammary Prostheses manufactured by Medtronicof Irvine, Tex. This adjustable implant utilizes a fill tube throughwhich saline may be introduced or removed from the implant to change theimplant's size. Thus, the adjustable implant may be used to change thesize of the capsule. Once the desired size of the capsule is achieved,the fill tube may be removed from the implant, thereby rendering theimplant non-adjustable. The implant may remain in the capsule.

SUMMARY

An adjustable implant is disclosed herein. The adjustable implant maycomprise a shell including a membrane and a base and having a firstdiameter in a plane parallel to the base. A band may be disposed withinthe shell. A mechanism including a spool may also be disposed within theshell. The band may have a first end and a second end. The first end maybe connected to the spool. The second end may also be connected to thespool. The band may be in a round (e.g., elliptical) configurationhaving a second diameter in the plane that is less than the firstdiameter.

In some embodiments, the mechanism may include a gear that is coupled tothe spool, a first pawl having a first pin, a second pawl having asecond pin, a first clip having a first groove and a first hole, and asecond clip having a second groove and a second hole. The first hole maybe mated about the first pin and the second hole may be mated about thesecond pin. The mechanism may also include an advancement actuatorhaving a first post mated to the first groove. The mechanism may alsoinclude a release actuator having a second post mated to the secondgroove. In some embodiments, the first pawl contacts a first tooth ofthe gear and the second pawl contacts a second tooth of the gear. Alever may also be included that has a first end connected to the firstpawl and a second end disposed proximate the second post.

In some embodiments, the mechanism may include a motor coupled to thespool. The motor may include a battery, such as a rechargeable battery.The motor may also include a communication module, e.g., awireless-communication module.

The band in the implant may be adjustable. That is, the second diametermay be decreased by wrapping the band onto the spool and the seconddiameter may be increased by unwrapping the band from the spool. In someembodiments, the implant includes a second or inner membrane within themembrane, and the band may be disposed about the inner membrane.

The implant may be used according the following exemplary method andvariations. The diameter of the band may be decreased and the height ofthe implant may be increased. Further, the diameter of the band may beincreased and the height of the implant may be decreased. The implantmay include a spool connected to a first end of the band such that theband may be wrapped onto the spool to decrease the diameter of the bandand the band may be unwrapped from the spool to increase the diameter ofthe band. In some variations, an advancement actuator may be depressedto rotate the spool in a first direction, which causes the band to wraponto the spool. In some variations, a release actuator may be depressedto rotate the spool in a second direction, which causes the band tounwrap from the spool.

For those embodiments that include a motor, the method may include astep of activating the motor to rotate the spool and wrap the bandthereon. The motor may be remotely activated via a remote control, suchas a Smartphone.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim the subject matter described herein, it isbelieved the subject matter will be better understood from the followingdescription of certain examples taken in conjunction with theaccompanying drawings, in which like reference numerals identify thesame elements and in which:

FIG. 1 depicts a perspective view of an adjustable implant having aspool mechanism;

FIG. 2 depicts an exploded view of the spool mechanism of FIG. 1;

FIG. 3 depicts a perspective view of the spool mechanism of FIG. 1;

FIG. 4 depicts a top view of the spool mechanism of FIG. 1;

FIG. 5 depicts a perspective view of an actuator body of the spoolmechanism of FIG. 1;

FIG. 6 depicts a section view of the spool mechanism of FIG. 1;

FIG. 7A depicts a front view of the adjustable implant of FIG. 1 havingan original profile;

FIG. 7B depicts a front view of the adjustable implant of FIG. 1 havinga heightened profile;

FIG. 8 depicts a perspective view of an alternate embodiment of anadjustable implant; and

FIG. 9 depicts a perspective view of another alternate embodiment of anadjustable implant.

DETAILED DESCRIPTION

The following description sets forth certain illustrative examples ofthe claimed subject matter. Other examples, features, aspects,embodiments, and advantages of the technology should become apparent tothose skilled in the art from the following description. Accordingly,the drawings and descriptions should be regarded as illustrative innature.

FIG. 1 is a representation of an exemplary embodiment of the presentsubject matter, i.e., adjustable implant 100. Adjustable implant 100includes a shell 102, which includes a base 103. Shell 102 includes ashell membrane 104 that may be fabricated from any resilient and/orstretchable material used to fabricate conventional implants,particularly breast implants. For example, elastomeric silicones, suchas silicone rubber, may be used to fabricate shell membrane 104. Shell102 may be filled with a material 106 to maintain a desired form andprevent shell membrane 104 from collapsing and deforming under its ownweight. In some embodiments, shell 102 has the form of a conventionalbreast implant, which is the form of shell 102 reflected in the figures.Further, material 106 may provide compliance and/or resiliency whenshell membrane is subject to external forces generated by, e.g., foreignobjects or a subject's anatomy. The material 106 may be, e.g., anelastomer, such as silicone rubber, a silicone gel, or a liquid, such assaline.

Adjustable implant 100 additionally includes a flexible band 108 made ofe.g., elastic, rubber, or plastic. Alternatively, it may be afluoropolymer, such as Teflon, which may provide certain advantages overother alternatives including low friction and bacterial resistance. Band108 may have a round configuration, including, but not limited to anelliptical (including circular) configuration, ovular configuration,annular configuration, disk configuration, or spherical configuration.Further, it may be oriented such that it may be parallel or nearlyparallel to base 103 of implant 100. The configuration of band 108includes a diameter θ that is less than the diameter of acircumferential portion 110 of shell 102 that is coplanar with band 108.In certain embodiments, the plane including circumferential portion 110and band 108 also includes the maximum diameter of implant 100. That is,band 108 is disposed in a plane where implant 100 is widest. Loops 109may be provided within material 106 in a round or ellipticalconfiguration. Loops 109 may additionally be attached to an innersurface of shell membrane 104. Band 108 may be disposed within loops 109in a manner similar to a belt in belt loops on a pair of pants. In someembodiments, a sheath (not shown) for band 108 may be provided. In theseembodiments, band 108 may be disposed within the sheath and the sheathmay be disposed through loops 109. The sheath may be fabricated from anymaterial that is also suitable for fabricating band 108, such as Teflon.

Implant 100 may have a maximum diameter ranging between approximatelythree inches and seven inches. In some embodiments, the maximum diameterθ of band 108 is approximately 0.2 inches to 1 inch less than themaximum diameter of implant 100. Band 108 may be a thin strip having athickness of between approximately 0.03 inches and 0.15 inches. Band 108may have a height of between approximately 0.25 inches and 1 inch.

Diameter θ of band 108 may be decreased or increased. When 0 isdecreased, band 108 squeezes material 106, which causes a correspondingincrease in height of shell 102. Further, in those embodiments includingloops 109, band 108 displaces loops 109, which may further facilitatesqueezing material 106 by evenly distributing the constrictive forcesupon material 106 caused by reducing diameter θ. Further, in thoseembodiments where loops 109 are attached or bonded to the inner surfaceof shell membrane 104, shell membrane 104 may further distribute theconstrictive forces. When 0 is increased, band 108 releases the portionof material 106 that was being squeezed, which causes a correspondingdecrease in the height of shell 102. In some embodiments, the height ofshell 102 may be increased by between approximately 0.2 inches and 2inches. In certain embodiments, the height of shell 102 may be increasedby approximately 0.5 inches.

Various embodiments of an adjustable implant are described herein, eachincluding a mechanism disposed within the adjustable implant for drivinga spool, or a “spool mechanism,” onto which a band may be wrapped. Forexample, as shown in FIG. 1, a spool mechanism 112 may be embeddedwithin material 106 of implant 100 and coupled to band 108 for changingthe diameter θ of band 108. Spool mechanism 112 may be controlled by asubject in which implant 100 is implanted (as opposed to requiringmanipulation by a health care professional).

Spool mechanism 112 is detailed in FIGS. 2-6. With initial reference toFIG. 2, which is an exploded view of mechanism 112, and FIG. 3, which isan assembly view of mechanism 112, mechanism 112 includes variouscomponents, including a spool 114, a rod 116, a gear 118, a first pawl120, a second pawl 122, a guide spring 144, a first lever 124, a secondlever 126, a first clip 128, a second clip 130, a plate 132 having tabs134 and 136, and an actuator body 138 on which are disposed advancingactuator 140 and release actuator 142.

Band 108 is attached to spool 114. The attachment may be effectuated byan adhesive or via mechanical means (e.g., cleats) securing it withinchannel 154. Thus, as spool 114 is rotated band 108 may be wrapped ontospool 114 or unwrapped from it. Band 108 may be attached to spool 114 atboth its first end 150 and second end 152 as shown in the figures.Alternatively, in some embodiments, band 108 may be attached to spool114 at only one of its ends 150 or 152. The other end may be attachedto, e.g., a stationary feature of mechanism 112, e.g., a post disposedproximate spool 114 and/or gear 118.

Spool 114 may be mated to gear 118 by rod 116, which mates within hole146. Further, spool 114 and gear 118 may be rotatably coupled to eachother. For example, spool 114 may include a post 115 that mates intohole 146. Alternatively, rod 116 and spool 114 may be keyed to eachother by including tongue and groove features upon rod 116 and withinhole 146. Accordingly, as gear 118 rotates, spool 114 rotates, causingband 108 to wrap onto or wrap off of spool 114.

Gear 118 may be rotated or advanced in a counter-clockwise direction bydisplacing a first pawl 120 against a gear tooth 119, which causes band108 to wrap onto spool 114, which reduces diameter θ. Due to theresilient nature of implant 100, and particularly shell membrane 104 andmaterial 106, reduction of diameter θ causes a spring-type tensionwithin band 108. Accordingly, ratchet functionality may be employed tohelp prevent this tension from unwinding band 108 from spool 114. Asecond pawl 122 may thus be included that contacts another gear tooth119 to resist clock-wise motion of gear 118. In various embodiments, notshown, a portion of gear 118 may lack gear teeth.

First pawl 120 and second pawl 122 may be operated by a user viaactuator body 138, which includes advancing actuator 140 and releaseactuator 142. First pawl 120 traverses a path delineated by guide spring144 and a slot 156 in plate 132 that retains a pin 158 of first pawl120. Depression of advancing actuator 140 displaces first pawl 120against a gear tooth 119, which causes gear 118 to rotate counterclockwise. Upon release of advancing actuator 140, first pawl 120returns to its original position. Pawl 120 may return to its originalposition under a spring force imparted by advancing actuator 140. Insome embodiments, advancing actuator may be a combination of anelastomeric bulb 141 and post 160. Post 160 may mate with first pawl120. As reflected in the figures, post 160 connects to a groove 164 offirst clip 128 and hole 166 of clip 128 mates about pin 158 of firstpawl 120. Thus, first pawl 120 is advanced upon depression of advancingactuator 140 and retracted upon release of advancing actuator 140.Second pawl 122 maintains the position of gear 118 as advancing actuator140 returns first pawl 120 to its original position.

Depression of release actuator 142 disengages second pawl 122 from gear118, thus allowing gear 118 to rotate clockwise. In some embodiments,including those reflected in the figures, first pawl 120 my also berotated away from gear 118 to remove its restriction to movement of gear118. Specifically, first lever 124 may include a first end connected tofirst pawl 120 and a second end disposed proximate post 162 of releaseactuator 142. When post 162 is displaced against the second end of firstlever 124 upon depression of release actuator 142, the first end offirst lever 124 displaces first pawl 120 away from gear 118 such thatfirst pawl 120 does not prevent clockwise rotation of gear 118.Accordingly, if band 108 is wound onto spool 114, band 108 will unwindfrom spool 114 because any resistance to rotation provided by secondpawl 122, and in some embodiments, first pawl 120, has been removed.Similar to advancing actuator 140 in some embodiments, release actuator142 may be a combination of an elastomeric bulb 143 and post 162. Post162 may mate with second pawl 122. As best seen with references to FIGS.2 and 6, post 162 connects to a groove 168 of clip 130 and hole 170 ofclip 130 mates about pin 172 of second pawl 122. Another pin 174 ofsecond pawl 122 mates into hole 176 of plate 132. Thus, as releaseactuator 142 is depressed, post 162 pushes clip 130 to advance pin 172,which causes clockwise rotation of second pawl 122 about pin 174,disengaging second pawl 122 from gear 118. The reverse occurs uponrelease of release actuator 142. That is, due to its elastomericresilient nature, post 162 returns to its original configuration andpulls clip 130 to withdraw pin 172, which causes counter-clockwiserotation of second pawl 122 about pin 174, re-engaging second pawl 122against gear 118.

Lever 126 may be included to assist in maintaining alignment betweenfirst pawl 120 and gear 118. For example, pin 158 may also mate withhole 178 of second lever 126 in addition to slot 156 of plate 132. Hole180 of second lever 126 may mate about stationary post 182 of plate 132.Thus lever 126 may rotate about a fixed point defined by post 182, whichhelps maintain alignment of the other moving parts in mechanism 112.

Mechanism 112 also includes tabs 134 and 136. Tabs 134 and 136 may befeatures of plate 132. Tabs 134 and 136 may be useful for attachingactuator body 138 to plate 132 with proper alignment to controlmechanism 112. Further, tabs 134 and 136 assist in maintaining theposition of mechanism 112 within shell 102 by resisting forces appliedto actuator body 138, particularly forces applied to advancing actuator140 and release actuator 142. In some embodiments not shown, actuatorbody 138 may be positioned near to the bottom of shell 102, i.e.,proximate base 103.

In some embodiments, mechanism 112 is oriented within implant 100 suchthat advancing actuator 140 and release actuator 142 are disposedproximate membrane 104 of shell 102. In some embodiments, advancingactuator 140 and release actuator 142 may contact an inner surface ofmembrane 104. Accordingly, a user in whom implant 100 is implanted mayactuate actuators 140 and 142 by pressing her skin proximate the desiredactuator.

Depression of advancing actuator 140 causes spool 114 to rotate counterclockwise, which in turn causes band 108 to wrap thereon. As band 108wraps onto spool 114, diameter θ of band 108 decreases, which causes acorresponding increase in height of shell 102. Conversely, depression ofrelease actuator 142 causes spool 114 to rotate clockwise, which in turnallows band 108 to unwrap therefrom. As band 108 unwraps from spool 114,diameter θ of band 108 increases, which causes a corresponding decreasein height of shell 102.

A cover or sheath (not shown) may be disposed upon or about spoolmechanism 112 to protect it from outside interference. For example, themoving parts of spool mechanism 112, e.g., spool 114, gear 118, firstpawl 120, and second pawl 122, should be covered to prevent material 106from interfering with these components, which could potentially causethe mechanism to malfunction.

FIGS. 7A and 7B reflect two different profiles of adjustable implant100. The profile of implant 100 may be changed from an original profile,reflected in FIG. 7A, to a heightened profile reflected in FIG. 7B. Thischange in profile is effected by reducing diameter θ of band 108 usingmechanism 112. The original profile may be recovered by enlarging thediameter θ of band 108 using mechanism 112. Intermediate profiles (notshown) may also be achieved by reducing diameter θ less than is requiredto achieve the heightened profile. Accordingly, a subject may change theprofile of implant 100 to her desired preference by using mechanism 112to change diameter θ of band 108.

It should be appreciated by those of skill in the art that the foregoingdescription of mechanism 112 is exemplary, as are the descriptions ofmechanisms 212 and 312 below. Alternative embodiments of thesemechanisms may be designed that could achieve diameter changes in band108, particularly after one of skill in the art has reviewed the presentdisclosure. Such design changes are considered to be within the scope ofthe present disclosed subject matter.

Implant 100 may be used according to the following exemplary method.First, implant 100 may be provided. Second, advancing actuator 140 maybe depressed, which causes pawl 120 to rotate gear 118, which in turnrotates spool 114 causing band 108 to wrap thereon. Third, repeateddepressions of advancing actuator 140 causes repeated rotations of gear118 and spool 114, further wrapping band 108 onto spool 114. In someembodiments, approximately fifteen depressions of actuator 140 resultsin a maximum length of band 108 being wrapped onto spool 114. As notedabove, in some embodiments, a portion of gear 118 may lack gear teeth.Thus, repeated depressions of actuator 140 will cause first pawl 120 toreach the portion of gear 118 that lacks teeth, thereby preventingfurther rotation of gear 118 and further wrapping of band 108 onto spool114. Fourth, the diameter θ of band 108 is decreased and the height ofimplant 100 is increased.

Fifth, release actuator 142 may be depressed. This step may occur whenany length of band is wrapped onto spool 114, e.g., when band 108 issubstantially wrapped thereon following, e.g., ten depressions ofadvancing actuator 140. Depressing release actuator 142 causes secondpawl 122 to rotate away from gear 118. In some embodiments, particularlythose where pawl 120 rests against gear 118, depressing release actuator142 also causes first pawl 120 to rotate away from gear 118. Thus,depressing actuator 142 disengages pawls 120 and 122 from gear 118,allowing it to rotate freely. Sixth, under the spring-type forces inband 108 imparted therein by winding band 108 onto spool 114, band 108unwinds from spool 114. Band 108 continues to unwind from spool 114until either release actuator 142 is released or band 108 unwrapsentirely from spool 114. Seventh the diameter θ of band 108 is increasedand the height of implant 100 is decreased.

The foregoing method may be applied by a subject in whom implant 100 isimplanted to change the height of the implant. Correspondingly, she maychange the projection of her breast. For example, the subject may beginwith implant 100 having a configuration in which band 108 has a maximumdiameter θ such that the height of shell 102 is a minimum. To increasethe projection of her breast, the subject may depress advancing actuator140 at least one time to decrease the diameter θ of band 108 andincrease the height of shell 102. For example, if the subject would likeher breast to be a little bigger, the subject may depress advancingactuator 140 approximately two to approximately four times, which, insome embodiments, may cause the height of shell 102 to increase about aquarter to one third from its minimum height toward its maximum height.Alternatively, if the subject would like her breast to be substantiallybigger, the subject may palpitate advancing actuator 140 about fifteento twenty times, which, in some embodiments, may cause the height ofshell 102 to increase to its maximum height.

After the subject has enlarged her breast, she may decide that she wouldlike to shrink her breast. To shrink her breast, she may depress releaseactuator 142 until her breast has reached the size she desires. However,if she shrinks her breast too much, she may enlarge it to the desiredsize by palpitating advancing actuator 140. In this manner, she may“fine tune” the projection of her breast. Further, she may do sowhenever she desires to change the size of her breast because theadjustability of implant 100 is a permanent feature of the implant thatcannot be removed. This is so because adjustable implant 100 is entirelyself-contained, like a conventional permanent implant, but unlikeconventional tissue expanders or the Becker Expander/Mammary Prostheses.No fluids, liquids, or other materials are introduced or removed fromwithin the boundary defined by shell membrane 104 in order to change theprofile of implant 100.

FIG. 8 shows an alternate embodiment of an adjustable implant. Implant200 includes a shell 202 having two membranes, an inner or firstmembrane 204 and an outer or second membrane 205 that surrounds innermembrane 204. Both inner membrane 204 and outer membrane 205 are filledwith material 206. Band 208 is disposed about and proximate to innermembrane 204. In some embodiments, loops 209 may be circumferentiallydistributed about and attached to inner membrane 204 such that band 208is further disposed within loops 209. Spool mechanism 212 may be used tochange a diameter of band 208 to change the profile of inner membrane204, which in turn changes the profile of outer membrane 205 and theoverall profile of implant 200. In some embodiments, mechanism 212 isdisposed between inner membrane 204 and outer membrane 205 such thatadvancing actuator 240 and release actuator 242 are proximate an innersurface of outer membrane 205.

In alternate embodiments, the spool mechanism may include a motor drivenby electromechanical energy. For example, FIG. 9 shows an adjustableimplant 300 that includes a spool mechanism 312. Instead of themechanical gears included in the foregoing embodiments, spool mechanism312 includes a motor 318, which may be, e.g., a dc motor, a steppermotor, servo motor, or piezoelectric motor. A piezoelectric motor mayavoid magnetic issues posed by MRIs. Motor 318 may include a shaft 316to which a spool 314 may be attached. In some embodiments, spool 314 andshaft 316 may be a single component. In other embodiments, shaft 316 mayserve as a spool. In those embodiments including an electromechanicalmotor, the profile of implant 300 may be changed using band 308 in amanner similar to implants 100 and 200 using bands 108 and 208. However,an electromechanical spool mechanism provides various potentialadvantages over a pure mechanical mechanism.

First, electromechanical spool mechanism 312 may be more accurate andless likely to malfunction than a spool mechanism with a gear and pawls,such as spool mechanism 112 and 212. Second, electromechanical mechanism312 may be more reliable because it includes fewer parts and shouldsubject to fewer user-based manipulations (e.g., different users maydepress actuators with varying amounts of force). Third,electromechanical mechanism 312 may be automated. Thus, it may beprogrammed at one time to wrap and unwrap band 308 from spool 314 atother times. Fourth, electromechanical mechanism 314 may include or beattached to a wireless antenna such that it may be remotely controlledby a user operating a remote control, which may assist a user inoperating her implant discretely and avoids potential manipulationthrough clothing. The remote control may include a storage medium intowhich various preset sizes of an adjustable implant may be set by theuser such that the user need not set the size of the implant whilewatching the implant. Instead, she may simple select a preset size,which may further assist changing the size of the implant discretely. Invarious embodiments, programming and remote controlling may beaccomplished via a remote device or control, including a Smartphoneoperating an appropriate application in communication withelectromechanical mechanism 312.

Electromechanical spool mechanism 312 may be actuated by a poweredstorage device, such as a battery, which may be rechargeable. Thebattery may be recharged wirelessly, e.g., by inductive charging orwireless charging. Ideally, electromechanical implant 312 prohibitsoperation when a battery is near empty to avoid an implant being unableto reach a desired size until after the battery is recharged.

It should be understood that any of the examples and/or embodimentsdescribed herein may include various other features in addition to or inlieu of those described above. The teachings, expressions, embodiments,examples, etc. described herein should not be viewed in isolationrelative to each other. Various suitable ways in which the teachingsherein may be combined should be readily apparent to those of ordinaryskill in the art in view of the teachings herein.

Having shown and described exemplary embodiments of the subject mattercontained herein, further adaptations of the methods and systemsdescribed herein may be accomplished by appropriate modificationswithout departing from the scope of the claims. Some such modificationsshould be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative. Accordingly, the claimsshould not be limited to the specific details of structure and operationset forth in the written description and drawings.

We claim:
 1. An adjustable implant, comprising: a shell including a baseand having a first diameter in a plane parallel to the base, the shellfurther including a membrane; a band disposed within the shell in around configuration and having a second diameter in the plane that isless than the first diameter, the band having a first end and a secondend; and a mechanism disposed within the shell, the mechanism including:a spool; a gear coupled to the spool; a first pawl having a first pin; asecond pawl having a second pin; a first clip having a first groove anda first hole mated about the first pin; a second clip having a secondgroove and a second hole mated about the second pin; an advancementactuator including a first post mated to the first groove; and a releaseactuator including a second post mated to the second groove, wherein thefirst end of the band is connected to the spool.
 2. The adjustableimplant of claim 1, wherein the second end of the band is connected tothe spool.
 3. The adjustable implant of claim 1, wherein the first pawlcontacts a first tooth of the gear.
 4. The adjustable implant of claim3, wherein the second pawl contacts a second tooth of the gear.
 5. Theadjustable implant of claim 3 further comprising a lever having a firstend and a second end, the first end connected to the first pawl and thesecond end disposed proximate the second post.
 6. The adjustable implantof claim 1, wherein the mechanism further comprises: a motor coupled tothe spool.
 7. The adjustable implant of claim 6, wherein the motorincludes a rechargeable battery.
 8. The adjustable implant of claim 7,wherein the motor includes a wireless-communication module.
 9. Theadjustable implant of claim 8, wherein the round configuration is anelliptical configuration.
 10. The adjustable implant of claim 1, furthercomprising an inner membrane surrounded by the membrane, wherein theband is disposed about the inner membrane.